Difficulty breathing Shallow and deep post cholecystectomy

[DCVAMCpt]

I had a cholecystectomy a week ago. I have a huge bruise on the right side measuring over 10x10 inches starting 2 inches medial to the most lateral port site extending to my back and about 2 inches above the port site( just above the anterior lower rib boarder) to just below the level of the femoral head (I did have decreased red blood count for two days post op prior to stabilization went from 46 to 32 day of surgery and 24 2 days post, (CT had been ordered but was canceled due to stabilization of cell count 40 hours post op). I have had issues with severe right side spasm pain with sharp almost tearing pain which is made worse with movement, especially ambulation and change from recumbent to semi recumbent to seating positions) which often originates in the mid RQU just below the rib cage but shoots through the chest to under the clavicle and into the shoulder/and sometimes neck at its worse includes left side. I have had difficulty breathing both shallow and deep and during spasm breathing and any movement makes the spasm worse.  I have been using the incentive spirometer but it is only after the use of valium that I am able to take semi deep breaths (have not been able to get above 1750ml breaths) I can take deeper breaths in a recumbent position more so than any others upright seated and standing are the most difficult. I am also having issues voiding freely except within the first few hours of using valium, I did have fluid retention which has pretty much resolved since the addition of valium q8 hrs. I have none of the symptoms I had pre-op to include nausea, vomiting, pain into the back. I keep being told by the doctors that it is normal to have pain breathing due to the CO2 used in the procedure but the nurses say they have not seen anyone have the bruising, spasms, and breathing issues I have had. Since I use VA medicine I am limited to the team on site. Any suggestions as if this is normal, if not what I should push to have looked into etc. I feel as though the doctors do not understand my issues as they are not a typical responses and in turn just want to get me out the door (will be transferring me to a rehab facility in the next 48 hours). I want to get off pain meds ASAP and able to breath and move once again. I have been reading everywhere but have not seen such issues. I had a prior abdominal surgery due to GYN issues and they did a lap appy and was off pain meds within 48 hours (which was just Tylenol and Motrin) back on my feet and kayaking in 5 days so this is totally abnormal for me. Please advise.

[DCVAMCpt]

Correction it was my alkaline phosphate what was high, was almost 300 which the alkaline phosphate has never been high where as my ALT and AST which wax and wane were stone cold normal.

[DCVAMCpt]

I ended up doing a walk in apt with my primary care doctor who ordered an ultrasound and blood work. The ultrasound showed a "good sized" fluid collection suggestive of a hematoma/clot where the gallbladder used to be. The blood work was suggestive for a clot and my AST which has never been elevated in the past is up and my platelets were 402. I was told that the hematoma/clot should clear up on its own although it will take ALOT of time and further pain. I was told that as long as I do not end up with an infection and as long as it does not continue to get larger there is nothing to be done. Is there anything I can do to increase my body's ability to reabsorb the clot? The pain increases with increased physical activity and decreases with rest is this normal for such a finding?

[S. Kaul, MD]

Hi there!

Though not particularly normal it is not uncommon to experience the post-op symptoms as described. Aside the trauma induced by the surgery, the bruising is more likely to have been caused by deranged blood cell counts. Since the counts have normalised further risk is decreased and the bruising is expected to heal in 1-3 weeks. The breathing issues could occur due to the CO2 used and may be compounded by conditions such as atelectasis, infections, inflammations, anxiety etc. While others are expected to resolve, an evaluation for a possible infection may need to be considered. I would suggest discussing with your treating gastroenterologist if a pulmonology consult would be sought in the case.
Hope the information is helpful.

Take care!